People In Mainland China Research Articles

Research on Macao Study Tour Policy and Cross-strait Cultural Construction on the Macao Local Government Cultural Industry—Taking the “Ten Thousand Persons Plan”

The development of Macao's study tour policy is closely related to the cultural industry. Its evolution has enriched cultural experience, promoted exchanges, and driven the coordinated development of the cultural tourism industry from "national education" to "national education + tourism". This study uses intergroup contact theory to thematically analyze 28 respondents' views on cross-strait relations and cross-strait culture. The results show that the study tour can promote exchanges between young people in Mainland China, Hong Kong SAR, Macao SAR and Taiwan Region; it can also directly meet the ideal conditions for intergroup communication mentioned by Allport, and have a positive impact on mainstream ideology and national identity. However, the government can create a cross-strait study tour circle. This circle can provide a better platform for strengthening indirect contacts between different regions. It makes up for the lack of direct contact conditions (spatial distance). This study fills the gap in the literature on enhancing cultural integration, identity construction, and cultural policy impacts among cross-strait youth through study tours, thereby providing a deeper understanding of the cultural relations between mainland China, the Macao SAR, and Taiwan region.

Sexual Identity Development, Psychiatric Risk, and Protective Factors Among Bisexual People in Mainland China, Hong Kong, and Taiwan.

Purpose: This study aimed to uncover sexual identity development and investigate the psychiatric risks for bisexual people across mainland China, Hong Kong, and Taiwan by examining ecologically informed factors at the individual, family, and community levels. Methods: An internet-based survey was administered to 685 respondents, from June to August 2021, reached primarily through lesbian, gay, bisexual, transgender, and queer community organizations and professional networks. Participants reported their demographics, identity milestones, and psychiatric symptoms. Results: Significant birth cohort and regional differences were observed regarding bisexual identity milestones. Individuals who were older, transgender and/or nonbinary, and based in Taiwan disclosed their sexual identity more. All respondents reported clinically elevated depression and anxiety symptoms, with a majority experiencing moderately severe depression (60%) and moderate or severe anxiety (80%). Approximately half of respondents contemplated suicide in the past year. Compared with cisgender women, identifying as transgender and nonbinary assigned female at birth was significantly associated with increased depression and higher odds of suicidal ideation in the past year. Enhanced self-esteem was associated with greater well-being and decreased psychiatric symptoms. Experiencing family shame was associated with increased anxiety and depression. At the community level, living in Hong Kong was linked to lower depression and suicidal ideation compared to mainland China. The presence of an LGBT group correlated with improved psychological well-being. Conclusions: Chinese bisexual people face substantial risks for depression, anxiety, and suicidal ideation, influenced by factors including self-esteem, transgender and nonbinary gender identity, family dynamics, and community context. Significant birth cohort and regional differences in bisexual identity development exist.

The effect of forest-environment construction on the physical activity among Chinese adults

The Chinese government attaches great importance to the construction of the National Forest City (NFC), aiming at creating a pleasant living environment beneficial for people’s health and well-being. This study aimed to estimate the effect of the NFC policy on the frequency of physical activity (PA) for people in mainland China. Using the nationally representative data from the China Family Panel Studies in 2010 and its follow-up in 2018, 17 704 participants aged 18 and older were analyzed in our study. We employed the two-way fixed estimator in the difference in difference setting to analyze the PA of the adults in the cohort with different development levels of the forest-environment construction measured by the number of NFCs, and explore the relative differences before and after the construction of NFC. Subgroup analysis of age group, gender and living areas and a series of robustness tests were further conducted. The mean age of 17 704 participants in 2010 was (45.03 ± 13.67) years old, 51.74% of which were female and 48.26% were male. DID results showed that after the construction of NFC, the frequency of PA increased by 1.35 (β = 1.35, 95% CI:0.73–1.98) per week compared to those in provinces without NFC after adjusting covariates. And the improving effect of the forest-environment construction on PA frequency was intensified in middle-aged and older adults aged 45 and above (β = 2.03, 95% CI:1.09–2.96), males (β = 1.26, 95% CI:0.39–2.12) and females (β = 1.49, 95% CI:0.58–2.40) and those living in urban areas (β = 1.29, 95% CI:0.57–2.00). Our findings showed that the forest-environment construction under the NFC strategy has a positive role in the PA of older adults, indicating the health-promoting effects of the national green low-carbon environmental strategy. Considering the heterogeneity, it is essential to promote the benefits of green exercise for young and rural adults.

From slash youth to flow workers: exploring the work issues behind the slash youth phenomenon in Mainland China

ABSTRACT In 2016, the slash youth phenomenon gained attention in mainland China. It was seen as an ideal work plan to adapt to contemporary conditions, and was even endorsed by Chinese state media. However, this paper challenges these narratives and examines the practicality of slash youth as a work plan. Through in-depth research and interviews with 20 slash workers, it explores the work problems faced by young people in mainland China and highlights the discrepancies between practice and narrative. In reality, most slash youth work as flow workers, a new type of labor subject shaped by the specific contextual conditions of mainland China. This type of work typically fails to provide a decent income or opportunities for personal growth, contradicting the promises of slash youth narratives. The transition from slash workers to flow workers reveals the limited employment options available and underscores the need for systemic changes in the nature of work. An integrated work culture and system that adapts to new forms of work is needed to avoid dire consequences.

Prevalence of hypertension and related risk factors in older Chinese population: a meta-analysis.

Hypertension is the most challenging public health problem worldwide and seriously affects human health. To date, there are no epidemiological studies on the prevalence of and risk factors for hypertension among older people in mainland China. We conducted a meta-analysis of the prevalence and risk factors of hypertension among the older population in mainland China. We searched Chinese and English databases for Chinese and English literature on hypertension epidemiology published between 2000 and 2022, and hypertension data among the older population were extracted from the included literature. A meta-analysis was performed using a random-effects model (I2 > 50%) with 95% confidence intervals for the forest plots. Data were processed using RevMan 5.3. Forty-nine publications (with data from 84,429 samples) met the evaluation criteria and were included in this study. We found that the total prevalence of hypertension was 47%. The total prevalence rate of the older population in China from 2000 to 2010 was 50%, and the prevalence rate from 2011 to 2021 was 45%, with no significant differences. The total prevalence in Central China was the highest (59%). There was no significant correlation between the prevalence rate of the older population, sex, and urban or rural areas. Hypertension is common among the older population in China, and its control rate is low. Therefore, effective prevention and treatment measures, as well as education, should be formulated to improve the diagnosis and treatment of hypertension in the older population.

Social accessibility in queering code/space: Blued-based visibility and social practices of local gay people in mainland China.

As a locative media, Blued articulates physical and digital space in the form of localization, giving a mediated visibility to its users who are not visible in physical space, thus making the city a queering code/space. This can transform social accessibility and the ways that gays come together and interact in local spaces. Taking mainland China, dominated by heteronomativity, as a field, this paper focuses on the visibility negotiation and social accessibility practices in Blued-based queering code/space. Using the digital anthropology method, this study found that Blued-based visibility is essential for non-closeted gay men to gain a sense of local belonging and community inclusion. Offline accessibility is a crucial demand for Blued users, but until then they have negotiated visibility through selective disclosure of social cues. At the same time, Blued users face visibility asymmetries and risks in the pursuit of accessibility. This study then argues that in the Blued-based queering code/space, the gay men constantly reconcile accessibility with others by managing visibility in a heteronormative urban space. In addition, this paper highlights the value of the hybrid of new media and physical space for the public interaction of marginalized groups in the city.

Is information evaluated subjectively? Social media has changed the way users search for medical information.

In recent years, social media platforms, such as TikTok and RedBook, have emerged as important channels through which users access and share medical information. Additionally, an increasing number of healthcare professionals have created social media accounts through which to disseminate medical knowledge. This paper explores why users obtain their medical information from social media and how the signals transmitted by social platforms affect use behaviours. We combined the elaboration likelihood model and signal theories to construct a comprehensive model for this study. We used simple random sampling to investigate users' behaviours related to social media usage. A total of 351 valid questionnaires were completed by people in Mainland China. The participants were enthusiastic about social media platforms and had searched for health-related information on social media in the past three months. We analysed the data using partial least squares structural equation modelling to investigate the influence of two pathways and two signals (objective and subjective judgement pathways and positive and negative signals) on social media use behaviours. When seeking medical information on social media, users tend to rely on subjective judgment rather than objective judgment, although both are influential. Furthermore, in the current era, in which marketing methods involving big data algorithms and artificial intelligence prevail, negative signals, such as information overload, have a more pronounced impact than positive signals. This study demonstrates that the subjective judgment path has a greater impact on users than the objective judgment path. Platforms are encouraged to focus more on users' emotional needs. The paper also discusses the negative impact of information overload on users, sounding an alarm for enterprises to control their use of homogeneous information resulting from the excessive use of big data algorithms.

Connecting differential psychological motivations for WeChat use with civic engagement: the significant role of bonding and bridging social capital

PurposeThe primary objectives of this article are to systematically explore whether and how certain WeChat use motives could lead to bridging social capital, bonding social capital and civic engagement among young people.Design/methodology/approachThe data was collected from a large-scale online survey of 1208 young people in mainland China. Zero-order correlation analyses and structural equation modeling were carried out to examine the corresponding hypotheses.FindingsObtained findings show that WeChat use for informational and social motivations are positively associated with bonding and bridging social capital. Moreover, bonding social capital could mediate the relationship between WeChat usage for informational and relational motivations and civic engagement.Research limitations/implicationsTheoretically, this article underlines the unique social and technological affordances of WeChat by exploring mobile social media use and how it would contribute to the quality of democracy by fostering young people's engagement in civic life. Practically, bridging and bonding social capital play significant roles in enhancing young people's civic engagement, which could be the meaningful resource for mobile social media designers, managers and government officials.Originality/valueThese obtained outcomes underlined the vital role of these newly emerging communication technologies in fostering democratic involvement and production of social capital in contemporary socially networked society.

Health Needs Assessment: Comparison of Applications of All-in-One AI Platform during the COVID-19 Pandemic between Mainland China and Hong Kong

Objectives: The COVID-19 pandemic has been a public health hazard since 2020. Preventive measures taken in mainland China and Hong Kong to control the spread of COVID-19, including quarantine, could potentially affect people's physical and mental health. Methods: We used a snowball sampling method to investigate the experience of people in mainland China and Hong Kong using AI chatbots during the COVID-19 pandemic to obtain information on mental health related to COVID-19, the current situation, and the multi-dimensional experience of using AI chatbots. The people who participated in the survey were residents aged 18-75 in the 2 areas. Results: The effective response rate of the questionnaire was 98%. Concerning demographics, 91.1% of the target group were 18-55 years old. The most important sources of information for the respondents were WeChat and Web pages. There was no difference between Hong Kong and mainland China in terms of access to COVID-19-related mental health information (??2=0.59, p=.444), and no difference shown in access to information by gender (??2=0.01, p=.942). There was no difference in age group (??2=2.97, p=.594) and was not related to whether respondents were in the provincial capital city area (??2=0.62, p=.429). Age groups “<18 years old” and “56-65 years old” were related to giving a higher (4 or 5) score to AI text questions answering chatbot (p=.030), and there is a positive relationship between the satisfactory of AI text question answering chatbot and that of AI voice question answering chatbot (R2=0.8074, p=.038). Conclusion: There is no significant difference in the use of all-in-one AI platforms in mainland China and Hong Kong, and both have large market potential in the field of AI services for mental health. This platform is suitable for people of all ages in both regions. The results of this study provide forward-looking guidance for our team to develop robots based on an all-in-one AI platform.

Do direct and indirect network externalities matter? Unpacking the causal antecedents of perceived gratifications and user loyalty toward mobile social media

PurposeBy building and examining an integral model, the principal objectives of this research are to systematically explore how indirect and direct network externalities lead to user loyalty toward WeChat through the mediating effect of perceived gratifications.Design/methodology/approachThe data were collected through an online survey of 688 young people in Mainland China. To empirically assess the conceptual model, zero-order correlation analyses and structural equation modeling were carried out utilizing web-based data.FindingsPath analysis results demonstrate that indirect network externalities and direct network externalities exert a significant impact on users' hedonic gratifications and utilitarian gratifications. Moreover, the study discovers the significant mediating influences of utilitarian gratifications on the association between indirect network externalities and user loyalty.Research limitations/implicationsTheoretically, this article may extend the scope of diverse studies on the association between network externalities and perceived gratifications and offer fresh insights into how mobile social media could actually improve user loyalty through enhancing perceived values among younger generation. Practically, this research assists mobile social media practitioners in retaining users and gaining competitive advantages over rival applications.Originality/valueAlthough the extraordinary growth of WeChat has successfully become the dominant media by which individuals develop interpersonal network and contact with others, the roles of perceived gratifications between network externalities and user loyalty toward WeChat have not yet been investigated in depth. These obtained outcomes not only enrich the existing literature regarding the relationship between network externalities and affective response, but also offer fresh insights to mobile social media designers, marketers and users.

How to Realize the Ideal Life of LGBT: Based on Field Observation of Mainland China

In this paper, the ideal life patterns of Chinese lesbian, gay, bisexual, and transgender (LGBT) are investigated. The ideal life includes the views of educational, policy environments, and LGBT-related organizations. The method employed is a semi-structured interview with questions about coming out experience, victimization, support networks, and demands. By the principle of identifying problems and seeking solutions, the inconveniences of LGBT life lead them to find their ideal objective environment by reviewing experience. Key results indicate that plebification outweighs explicit stipulations of anti-discrimination for LGBT people in Mainland China, which addresses the entrenched stigma from a demand perspective. These findings highlight the needs and expectations of living conditions in daily life occasion for LGBT people. Findings also have implications for LGBT-specific laws and regulations regarding suggestions for sex education and plebification in workplaces or schools in Mainland China.

Cognitive Limits, Herding Effects, and Group Segregation: Stigma Generation and Destigmatization Pathways of Hepatitis B Patients in China

Hepatitis B, once the number one epidemic in China, afflicted nearly 300 million Chinese people. Today, it is still the number one killer of infectious diseases. Due to the strong pathogenicity of hepatitis B, many people in mainland China are scared of the disease. They are afraid to avoid it, leaving many hepatitis B patients and even carriers to suffer much discrimination. They are typically denied the right to work, live and marry because of hepatitis B. As a result, many people with hepatitis B and those who are carriers of the virus suffer from stigma. In this paper, the authors analyze data on hepatitis B patients and pages, as well as data published by the Chinese Ministry of Health on hepatitis B, to connect the dots between the daily lives of hepatitis B patients and the discrimination they face in China. This will help researchers and the general public to understand hepatitis B and to reduce or even eliminate the fear of hepatitis B. Nowadays; the Chinese government has begun to help the general public understand and eradicate the fear of hepatitis B through health legislation, daily publicity, and education, to give these people a fair and just environment to live in.

Pneumococcal vaccination coverage and willingness in mainland China.

To estimate the coverage and willingness of pneumococcal vaccination and further explore the influencing factors of vaccination willingness among people in mainland China. Literature searches were conducted independently by two researchers in English- and Chinese-language databases from database inception to 6 October 2021. A random-effects meta-analysis model was used to derive summary vaccination coverage and willingness. Predefined subgroup analysis and meta-regression were performed to explore the sources of heterogeneity. A total of 97 studies were included in this meta-analysis. The summary vaccination coverage in 76 included studies was 21.7% (95% confidence interval [CI]: 17.2%-26.5%). Subgroup analysis shows that the summary coverage was 29.0% (95% CI, 20.4%-39.1%) among the permanent residents and 20.7% (95% CI, 12.4%-35.9%) among the floating residents. The eastern and central regions presented higher coverage than the western region. Notable differences were observed between the various study populations. A total of 27 studies provided an estimation of vaccination willingness, with a summary willingness of 51.2% (95% CI, 40.4%-61.9%). In subgroup analysis, the summary willingness was 57.9% (95% CI, 48.3%-67.2%) in urban areas and 52.3% (95% CI, 40.8%-63.8%) in rural areas. Parents with children and people with a history of pneumonia were more willing to be vaccinated than the elderly. Recommendations by family members and physicians, previous pneumococcal and influenza vaccination, perceived vaccination effectiveness and severity of disease and a history of pneumonia contributed to vaccination willingness. Compared to global estimates and other countries, pneumococcal vaccination coverage and willingness are at a lower level in mainland China. Recommendations for vaccination by family members and doctors, a history of vaccination and the perception of pneumonia and vaccination are associated with greater willingness to be vaccinated.

Exploring the mediating role of government–public relationships during the COVID-19 pandemic: A model comparison approach

This study proposed, tested, and compared three models to examine an antecedent and outcome of government–public relationships. It conducted three surveys of 9675 people in mainland China, Taiwan, and Hong Kong from August 2020 to January 2021. The results of the model comparison supported the proposed reciprocal model: not only were relational satisfaction and relational trust found to mediate the effect of perceived responsiveness on people’s word-of-mouth intention to vaccinate, but they also had a reciprocal influence on each other. This study further affirmed that the relative effects between satisfaction and trust. We also found that emotion-dominant model is more powerful than cognition-dominant model, i.e., people’s feeling of satisfaction happens before sense of trust, which results from their perceived organizational responsiveness and then contribute to their word-of-mouth behavioral intention. The theoretical and practical implications of this study were also discussed.

Can WeChat really foster young people's civic engagement? Unraveling an underlying mechanism from the social capital theoretical perspective

PurposeBuilding upon social capital theoretical foundation, the principal purpose of present research is to construct a conceptual research model and uncover the intricate relationships between WeChat usage, social capital and civic participation behaviors among young people.Design/methodology/approachA large cross-sectional valid data from 1,238 young people in mainland China were gathered to examine the hypothesized research model. Descriptive analyses, correlation analysis and structural equation modeling (SEM) were sequentially undertaken to determine dynamic interrelationships among main constructs.FindingsThe empirical findings demonstrate that WeChat usage positively impacts young people's social interaction ties, the guanxi network and shared goals. Moreover, social interaction ties and shared goals are positively associated with their online civic engagement. Furthermore, the guanxi network is positively associated with both online and offline civic engagement.Research limitations/implicationsTheoretically, this research is the first to explicitly explore the influence mechanism of WeChat use intensity on different dimensions of individual-level social capital and civic engagement. Practically, these obtained results can be beneficial to the comprehending of whether and how WeChat is a resource for social capital and civic involvement.Originality/valueDespite mobile social media, especially WeChat, has achieved immense popularity in contemporary mainland China, the potential influence of this emerging technology use on individuals' differential dimensions of social capital and civic engagement has not been systematically investigated. The study may not only offer fresh insight into innovative features of WeChat but also contribute to broader controversies regarding the impact of mobile-mediated communication on individuals' daily civic lives.

Burden of falls among people aged 60 years and older in mainland China, 1990–2019: findings from the Global Burden of Disease Study 2019

SummaryBackgroundFalls in older people have become a major public health concern worldwide, but a comprehensive assessment of the burden of falls for older people in mainland China has not been done. We aimed to investigate the burden of falls among older people at the national and subnational level in mainland China, and explore the trends from 1990 to 2019, using data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019.MethodUsing data from GBD 2019, we estimated the burden of falls among people aged 60 years and older by sex and age group in terms of incidence, mortality, and disability-adjusted life-year (DALY) rates and assessed these indicators at the subnational level in 31 geographical units (hereafter called provinces). We investigated the overall trend in the burden of falls across these 31 provinces from 1990 to 2019, and assessed the change in the burden of falls by sex, age group (60–64, 65–69, 70–74, 75–79, and ≥80 years), and province between 1990 and 2019.FindingsIn 2019, in mainland China, the incidence rate of falls among people aged 60 years and older was 3799·4 (95% uncertainty interval [UI] 3062·4–4645·0) new falls per 100 000 population, and 39·2 deaths (21·8–48·8) per 100 000 population and 1238·9 DALYs (920·5–1553·2) per 100 000 population were due to falls. We found no significant difference in the burden of falls between males and females. The incidence, mortality, and DALY rates of falls for people aged 80 years and older were significantly higher than those in the other age groups, except for incidence rate, which was non-significantly different between the age 75–79 years group and the oldest age group. Large variations in the incidence and DALY rates of falls were observed across 31 provinces. Although between 1990 and 2019 we found no significant changes in overall mortality due to falls in all provinces and in DALY rates for 23 provinces (DALY rates significantly decreased in two provinces and increased in six provinces), we found large increases in the incidence rate of falls in both males (percentage change between 1990 and 2019: 82·9% [67·4–100]) and females (77·0% [63·3–91·8]). The percentage change in incidence rate of falls between 1990 and 2019 varied from 50·0% (42·2–59·5) for people aged 60–64 years to 123·8% (105·4–141·9) for people aged 80 years and older. All provinces had significant increases in the incidence rate of falls between 1990 and 2019, with Sichuan having the greatest increase (148·5% [125·5–171·4]) and Jilin the smallest increase (14·7% [3·6–26·1]).InterpretationBetween 1990 and 2019, the incidence rate of falls increased substantially in older adults across mainland China, whereas the rates of mortality and DALY of falls among older people remained relatively stable, suggesting improvements in outcomes of falls. Nevertheless, falls remain an ongoing health burden for older people in mainland China, and there is an urgent need to introduce system-wide, integrated, and cost-effective measures to protect and support older people to minimise their risks and combat an increasing absolute burden as the population continues ageing.FundingBill & Melinda Gates Foundation.

Falls prevention in China: time for action

Falls prevention in China: time for action

The Burden of Falls of People Aged 60-Year-Old and Above in Mainland China, 1990-2019: Findings from the Global Burden of Disease Study 2019

Background: Falls in older people have become a major public health concern worldwide but a comprehensive assessment of falls burden for older people in mainland China has not been undertaken. This study aims to investigate the falls burden of people aged 60 years and above at the national and subnational level in mainland China, and explore the trends from 1990 to 2019, using data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019. Method: Using data from GBD 2019, we described the falls burden of older people by sex and age group in terms of incidence, mortality, and disability-adjusted life year (DALY) rates and evaluated these indicators at the subnational level from 31 provinces. The overall trend of falls burden was investigated across 31 provinces from 1990 to 2019, while the change of falls burden in different sexes, age groups and provinces were compared between 1990 and 2019. Findings: In 2019, the incidence rate of falls among people aged 60 years and above was 3799·4 new falls per 100 000 (95% uncertainty interval [UI] 3062·4–4645·0), while there were 39.2 deaths (95%UI 21·8–48·80) per 100 000, and 1238·9 DALYs (95%UI 920·5–1553·2) per 100 000 in mainland China. There was no significant difference in the falls burden between males and females. The incidence, mortality and DALY rates for people aged 80 years and above were significantly higher than other age groups. Large variations in incidence and DALY rates were observed across 31 provinces. Although there were no significant changes in the overall falls mortality in all provinces and DALY rates of 23 provinces from 1990 to 2019, there were large increases in the incidence rate in both males (82·9%, 95%UI 67·4%–100·0%) and females (77·0%, 95%UI 63·3%–91·8%) over the last three decades. The increases in the incidence rate varied from 50·0% (95%UI 42·2%–59·5%) for people aged 60–64 years to 123·8% (95%UI 105·4%–141·9%) for people aged 80 years and above. All provinces had significant increases in the incidence rate with Sichuan being the highest (148·5%, 95%UI 125·5%–171·4%) and Jilin the lowest (14·7%, 95%UI 3·6%–26·1%). Interpretation: Between 1990 and 2019, the incidence rate of falls increased substantially regardless of sex, age group and province, whereas the mortality and DALY rates of falls among older people remained relatively stable, suggesting improvements in outcomes of falls. Minor sex disparity in incidence and mortality rates was identified in the older population. The group at the highest risk of falls was males aged 80 years and above. Provincial inequality was found in the incidence and DALY rates of falls. Falls remain as an ongoing health burden for older people in mainland China, and there is an urgent need for introducing system wide, integrated and cost-effective measures to protect and support older people to minimise the risks and combat this growing burden as the population is aging. Funding: Bill & Melinda Gates Foundation. Declaration of Interest: We declare no competing interests.

Advance care planning for older people in mainland China: An integrative literature review.

Recently, the attempts to promote advance care planning (ACP) and advance directives (ADs) have appeared in mainland China. However, anecdotal evidence suggests that the concept of ACP and ADs is not widely known to the public and healthcare professionals. To examine and synthesise currently available research about ACP and ADs for older people in mainland China, and to discuss implications for future nursing practice and research. An integrative literature review. A systematic search was conducted in seven English electronic databases (CINAHL, MEDLINE, ProQuest, Cochrane, JBI, Scopus and Wiley) and four Chinese electronic databases (CNKI, Wanfang, VIP and CBM). Eligible articles were critically appraised using the Mixed Methods Appraisal Tool (MMAT). From various groups including older people, families and healthcare professionals, low levels of knowledge and awareness about ACP and ADs are reported. Demographic characteristics such as age, gender, education and clinical conditions were related to positive or negative attitude towards ACP. The main reason people cited for being 'reluctant/fairly reluctant' to make an AD was that they were 'Not familiar with it'. Given that older people showed positive attitudes towards ACP, policy support and practice guidelines about ADs and ACP are necessary to respect their wishes and to guide healthcare professionals in mainland China.

Percutaneous Vertebroplasty Versus Kyphoplasty for Thoracolumbar Osteoporotic Vertebral Compression Fractures in Patients with Distant Lumbosacral Pain

In clinical practice, we have found that the pain caused by thoracolumbar osteoporotic vertebral compression fracture (OVCF) is sometimes not limited to the level of the fractured vertebrae but instead occurs in areas far away from the injured vertebrae, such as the lower back, area surrounding the iliac crest, or buttocks, and this type of pain is known as distant lumbosacral pain. The pathogenesis of pain in distant regions caused by thoracolumbar OVCF remains unclear. To compare the clinical efficacy and imaging outcomes of percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty (PKP) in the treatment of distant lumbosacral pain accompanied by thoracolumbar OVCF and to explore the possible pathogenesis of distant lumbosacral pain caused by thoracolumbar OVCF. Retrospective study. A university hospital spinal surgery departments. A total of 62 patients who underwent vertebral augmentation for thoracolumbar OVCF with lumbosacral pain were included and divided into the PVP group (28 cases) and the PKP group (34 cases). The Visual Analog Scale (VAS) was used to evaluate the severity of local and distant lumbosacral pain, and the Chinese modified Oswestry Disability Index (CMODI) was used for functional assessment. The anterior vertebral height (AVH) of the fractured vertebrae and local kyphotic angle were measured on plain radiographs. The average follow-up time was 28.62 ± 8.43 months in the PVP group and 29.22 ± 9.09 months in the PKP group. Within the 2 groups, the VAS score of local pain, VAS score of distant lumbosacral pain, and CMODI score at 3 days postoperatively and at the last follow-up improved significantly compared with the scores before surgery. However, there was no significant difference between the 2 groups. At 3 days postoperatively and at last follow-up, the AVH and Cobb angle in the 2 groups improved significantly compared with those before surgery, but the magnitudes of AVH improvement and Cobb angle correction were significantly larger in the PKP group than in the PVP group. First, this study is retrospective and may be prone to selection bias. Second, because of cultural and linguistic differences, the original version of the Oswestry Disability Index could not be properly understood and completed by people in mainland China. Therefore in this study, the CMODI was used, but the correlation coefficients of the CMODI within and between groups were 0.953 and 0.912, respectively. Third, a pain diagram was not used to accurately reflect the location of pain in the distant lumbosacral region. Both PVP and PKP can effectively alleviate pain in the distant lumbosacral region caused by thoracolumbar OVCF, and distant lumbosacral pain associated with thoracolumbar OVCF may be considered vertebrogenic referred pain.